369 Medical Practice PC
Physical Medicine & Rehabilitation in Eastchester, NY. Organization (NPI-2).
NPI number1376141325
StatusActive
Last updated in NPPESOct 17, 2023
Details
- NPI
- 1376141325
- Entity type
- Organization (NPI-2)
- Legal business name
- 369 Medical Practice PC
- Organization subpart
- No
- Enumeration date
- Oct 13, 2020
- Certification date
- Oct 17, 2023
- Last updated
- Oct 17, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208100000X | Physical Medicine & Rehabilitation | – | – | Yes |
| 207Q00000X | Family Medicine | – | – |
Practice location
369 White Plains Rd Fl 2Eastchester, NY 10709-2805
Phone 914-395-3691
Mailing address
369 White Plains RdEastchester, NY 10709-2805
Phone 914-369-3691
Other practice locations
189 Us Highway 46
Saddle Brook, NJ 07663-6215
Saddle Brook, NJ 07663-6215
Phone 914-369-3691
Authorized official
Mack Sullivan
Owner
9143953691
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